PLEASE TAKE NOTICE that the
rent is past due on the above-described premises which you currently
hold and occupy. Your rental account is delinquent in the amount
itemized as follows:

Rental Period:
___________________________ Rent Due: $_________

Rental Period:
___________________________ Rent Due: $_________

Rental Period:
___________________________ Rent Due: $_________

Total Rent Due: $_________

Less Partial Payment of:
$_________

Total Balance Due:
$_________

You are hereby required to
pay said rent in full within ______ days or remove your possessions
from the above-described premises, or legal proceedings will be
instituted against you to recover possession of said premises, to
declare the forfeiture of the Lease or Rental Agreement under which
you occupy said premises and to recover rents and damages, together
with court costs and attorney's fees, according to the terms of your
Lease or Rental Agreement dated __________________ (Date).

_______________________________

Owner/Manager

Proof of Service

I, the undersigned, being
at least 18 years of age, declare under penalty of perjury that I
served the above notice, of which this is a true copy, on the
above-named tenant in possession in the manner indicated below:

ï¿½ On
______________________ (Date), I handed the notice to the tenant
personally.

ï¿½ On
______________________ (Date), after attempting personal service, I
handed the notice to a person of suitable age and discretion at the
residence/business of the tenant, and I deposited a true copy in the
U.S. Mail, in a sealed envelope with postage fully prepaid, addressed
to the tenant at his place of residence on ______________________(date
mailed, if different from above date).

ï¿½ On
______________________ (Date), after attempting service in both
manners indicated above, I posted the notice in a conspicuous place at
the residence of the tenant, and I deposited a true copy in the U.S.
Mail, in a sealed envelope with postage fully prepaid, addressed to
the tenant(s) at his place of residence on
________________________(date mailed, if different from above date).

Executed on
________________________ (Date), at the City of ___________________,
County of _______________, State of ___________________.

Served by:
______________________________

Warning:

These forms are provided
AS IS. They may not be any good. Even if they are good in one
jurisdiction, they may not work in another. And the facts of your
situation may make these forms inappropriate for you. They are for
informational purposes only, and you should consult an attorney before
using them.